Clinical Radiation Oncology

Clinical Radiation Oncology

Clinical Radiation Oncology, edited by Drs. Gunderson and
Tepper, is a first-edition textbook designed primarily for those in the field of
radiation oncology. However, the book attempts to present a multidisciplinary
approach to cancer treatment and may be of interest to surgical and medical
oncologists as well.

The editors realized that no single editor or group of editors
has sufficient expertise in all subjects to write a comprehensive textbook.
Thus, eight associate editors were selected to assist in the compilation of this
text, which features the contributions of 142 authors. Many of the authors are
recognized experts in their field. The material presented is up-to-date and
extensively referenced.

The book is divided into three logically organized sections. The
first section, "Scientific Foundations of Radiation Oncology," covers
the basic principles of radiation oncology, surgical oncology, and chemotherapy.
Included are chapters on the interactions of chemotherapy and radiation along
with basic statistics and clinical trials. The chapters on the principles of
surgical oncology and chemotherapy are short and designed to provide the reader
with the basics necessary for a rudimentary understanding of these specialties.

The second section, entitled "Techniques and
Modalities," contains eight chapters that focus on the principles of
radiation techniques. Within the section are chapters on (1) brachytherapy, (2)
intraoperative irradiation, (3) stereotactic irradiation, (4) particle
radiation therapy, (5) three-dimensional (3D) conformal radiation, (6)
hyperthermia, (7) radioimmunotherapy, and (8) palliation of metastases. The
chapters begin with a discussion of the technical background of each modality
and end with examples of clinical applications. Except for hyperthermia and 3D
conformal radiation therapy, the technical descriptions in most chapters lack
depth. A major portion of each chapter is devoted to the clinical applications
of each technique and focuses on its usefulness in specific disease sites.

Additional technical information is presented as it applies to
the specific disease site, along with the results of treatment. These chapters
emphasize the disease- and site-specific results of treatment, and although the
clinical examples are useful, it would have been more helpful if such
information on clinical outcome had been presented instead in the third section,
on disease sites.

I was surprised that a new textbook on radiation oncology did
not devote a chapter to intensity-modulated radiation therapy. This is the
latest advance in the delivery of radiation treatment and a major area of
investigation in oncology. It is mentioned in passing in the chapters on
stereotactic radiosurgery and 3D conformal radiation. However, a full formal
presentation of this technique and its vast potential is lacking.

The third and largest section of the book is entitled
"Disease Sites." In this section, there are 10 major subdivisions
devoted to the major disease sites. Each subdivision contains individual
chapters on specific disease sites. For example, the subdivision on
"Thoracic Tumors" contains chapters devoted to small-cell lung cancer,
non-small-cell lung cancer, and esophageal cancer.

The editors have attempted to maintain a consistent format
throughout the disease site section. Each subdivision begins with an overview of
the disease. Many of the overviews are concise summaries of the group of related
diseases explored in the chapters that follow. The better overviews discuss
general epidemiology, biology, and treatment considerations, and highlight some
of the controversial aspects of the diseases in question. However, some of the
authors choose to discuss a few unusual disease sites instead of providing a big
picture. For example, the author of the overview on genitourinary tumors refers
the reader to the individual chapters on each disease and, rather than providing
a brief summary, discusses the esoteric topic of penile cancer.

The individual chapters are well thought out and presented in a
consistent format to enhance their usefulness. The opening page of each chapter
begins with a capsule summary of the disease in question. This summary
highlights the incidence, staging, and typical treatment options in a short,
easy-to-read tabular format. Most chapters contain discussions of etiology,
prevention, detection, patterns of spread, therapeutic options, results, and
toxicity. Many also contain useful information on treatment planning. Treatment
outcome data are presented for each site, in most cases including local control,
distant control, and survival rates.

The text is unique in its presentation of treatment algorithms
at the end of most of the site-specific chapters. This provides the reader with
a quick method of determining the optimal treatment for an individual patient.
Unfortunately, not all chapters have algorithms, and some algorithms are more
useful than others.

In summary, the text is well edited, and the consistent format
makes the volume easy to use. The information presented is well researched and
up-to-date. The discussions of radiation therapy techniques as they pertain to
each disease site and frequent use of illustrations are particularly good.
Standard treatments are presented clearly, and controversial areas are
highlighted.

The shortcomings of the text include the lack of a section on
intensity-modulated radiation therapy and the lack of depth in some chapters.
Also, the book could benefit from a few organizational changes. For example, the
color plate illustrations are grouped and appear far from their citations in
text. Nevertheless, the text is a good overview of current issues in radiation
oncology.

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